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No. of bitstreams: 1 LUCAS_ANDRE_SCHUSTER_DE_SOUZA_DIS.pdf: 2261551 bytes, checksum: 6d2ae6206b912e63a5477cc83923cef8 (MD5) Previous issue date: 2018-03-08 / Introduction: Obesity is a complex and multifactorial condition that represents a risk factor for several other health problems and reductions in quality of life. The high prevalence and growing incidence of obesity in the world makes it necessary to identify the predisposing factors and effective intervention strategies for its treatment. One of the most important aspects in the treatment of obesity is the promotion of more adaptive eating behaviors and the reduction of problematic eating behaviors. It is currently recognized that emotional regulation is an important element in the etiological equation and maintenance of problematic eating behaviors in obesity and in some eating disorders related to obesity, especially binge eating. Dialectical Behavioral Therapy (DBT) is a behavioral therapeutic approach whose effectiveness has been demonstrated for a wide range of psychopathological conditions in which difficulties with emotional regulation are present. Although there are already several studies demonstrating DBT's efficacy in the context of eating disorders and obesity, in Brazil, research with DBT is still scarce and there are no empirical studies to date about its application to eating disorders. Considering this scenario, two studies were proposed to identify the effectiveness and maintenance of the effects of a group intervention based on the training of TCD Skills for obese people. Goals: To verify the maintenance of effects on problematic and adaptive eating behaviors after a group intervention based on Dialectic Behavioral Therapy for obese people, and to explore relevant aspects of the participants' experience with the intervention. Method: sequential quantitative and qualitative design, using self-report measures and semi-directed interviews. On the quantitative stage, self-report measures of problematic eating behaviors (Binge Eating Scale - BES, Emotional Eating Scale - EES) and adaptive (Mindful Eating Eating Questionnaire - MEQ, Intuitive Eating Scale 2 - IES-2) were used. An intention-to-treat analysis (n = 121) was used with all participants who were assigned for the intervention. Measures were taken at pretest, post-test and 3 and 8 months follow-up. Descriptive analyzes and hierarchical linear modeling were used to verify the effectiveness and stability of the effects of the intervention. In the qualitative phase, semi-directed interviews were conducted with 3 participants who concluded the intervention, focusing on the experience with the intervention, perceived effects, 31 facilitators and difficulties with the participation and implementation of the strategies developed in the treatment. The interviews were analyzed by four researchers, using inductive thematic analysis. Results: There was a significant reduction in problematic eating behaviors after the intervention, with stable results at the three-month follow-up and slight return towards baseline at 8-month follow-up. As for adaptive eating behavior, there was improvement after the intervention, which was maintained at three months follow-up and tended to return to baseline at 8 months follow-up. Analysis of the interviews revealed that participants identified improvements in various aspects of their life after the intervention, especially in interpersonal functioning and in the ability to regulate their own behavior. They point the identification with other group members and the presence of a supportive family and social environment as facilitators of participation in the intervention. Experiences of anxiety and aversive emotions during the group and difficulty in maintaining skills practice outside the sessions were pointed out as obstacles to the effectiveness of the intervention. Discussion: Quantitative results are consistent with other literature findings on DBT interventions in the context of eating disorders and demonstrate that a brief intervention based on DBT and adapted to the Brazilian context may be effective in reducing problematic eating behaviors and promoting more adaptive behaviors in the short and medium term for obese people, however they are not conclusive as to the maintenance of these changes for 8 months or longer. Data from the qualitative study replicated in part other findings in the literature on DBT for people with emotional dysregulation and borderline personality disorder, stressing the importance that clinicians be attentive to aversive emotional experiences during the group and provide support as well as identify opportunities for application of the skills during the group sessions. In addition, the perception of improvement in interpersonal relationships reflects the importance of the interpersonal dimension in obesity and binge eating, highlighting the strong relationship between interpersonal aspects and emotional responses to which maladaptive coping strategies such as overeating may follow. / Introdu??o: A obesidade ? uma condi??o complexa e multifatorial que representa um fator de risco para diversos outros problemas de sa?de e preju?zos ? qualidade de vida. A elevada preval?ncia e crescimento da quantidade de casos de obesidade no mundo, torna necess?rio que se identifiquem os fatores predisponentes e estrat?gias de interven??o eficazes para seu tratamento. Um dos aspectos mais importantes no tratamento da obesidade consiste na promo??o de comportamentos alimentares mais adaptativos e redu??o dos comportamentos alimentares problem?ticos. Reconhece-se atualmente que a regula??o emocional ? um elemento de grande import?ncia na equa??o etiol?gica e na manuten??o dos comportamentos alimentares problem?ticos na obesidade e em alguns transtornos alimentares correlatos da obesidade, em especial a compuls?o alimentar. A Terapia Comportamental Dial?tica (TCD) ? uma abordagem terap?utica de base comportamental cuja efic?cia vem sendo demonstrada para uma ampla gama de condi??es psicopatol?gicas nas quais est?o presentes dificuldades com a regula??o emocional. Apesar de j? haver diversos estudos demonstrando efic?cia da TCD no contexto dos transtornos alimentares e da obesidade, no Brasil, ainda ? escassa a investiga??o com aplica??es da TCD, e inexistente no caso de estudos emp?ricos sobre sua aplica??o a dist?rbios relacionados ao comportamento alimentar. Em face de tal cen?rio, prop?s-se a realiza??o de dois estudos com objetivo de identificar a efetividade e manuten??o dos efeitos de uma interven??o em grupo baseada no treinamento de Habilidades da TCD para pessoas obesas. Objetivos: verificar manuten??o dos efeitos sobre comportamentos alimentares problem?ticos e adaptativos ap?s uma interven??o em grupo baseada na Terapia Comportamental Dial?tica para pessoas obesas, e explorar aspectos relevantes da experi?ncia dos participantes com a interven??o. M?todo: desenho sequencial quantitativo e qualitativo, utilizando medidas de autorrelato e entrevista semidirigida. Na etapa quantitativa, utilizaram-se medidas de autorrelato de comportamentos alimentares problem?ticos (Escala de Compuls?o Alimentar Peri?dica - ECAP; Emotional Eating Scale - EES) e adaptativos (Mindful Eating Questionnaire - MEQ; Intuitive Eating Scale 2 - IES-2). Utilizou-se uma an?lise intention-to-treat (n=121) com participantes 28 selecionados para a interven??o. Foram realizadas medidas de pr?-teste, p?s-teste e seguimento de 3 e de 8 meses ap?s a interven??o. An?lises descritivas e modelagem linear hier?rquica foram utilizadas para verificar a efetividade e estabilidade dos efeitos da interven??o. Na fase qualitativa, entrevistas semidirigidas foram conduzidas com 3 participantes que conclu?ram a interven??o, enfocando a experi?ncia com a interven??o, efeitos percebidos, facilitadores e dificuldades com a participa??o e implementa??o das estrat?gias desenvolvidas no tratamento. As entrevistas foram analisadas por quatro pesquisadores, utilizando o procedimento de an?lise tem?tica indutiva. Resultados: verificou-se uma redu??o significativa nos comportamentos alimentares problem?ticos logo ap?s a interven??o, com resultados est?veis no seguimento de tr?s meses e levemente elevados no seguimento de 8 meses. Quanto ao comportamento alimentar adaptativo, houve melhora logo ap?s a interven??o, com resultados tamb?m est?veis aos tr?s meses de seguimento e tendendo a retornar aos valores iniciais aos 8 meses de seguimento. As entrevistas revelaram que os participantes identificaram melhoras em diversos aspectos de sua vida ap?s a interven??o, especialmente no funcionamento interpessoal e na capacidade de regular o pr?prio comportamento. Apontam a identifica??o com outros membros do grupo e a presen?a de um ambiente familiar e social suportivo como facilitadores da participa??o na interven??o. Experi?ncias de ansiedade e emo??es aversivas durante o grupo e dificuldade de manter a pr?tica das habilidades fora das sess?es foram apontadas como obst?culos para a efetividade da interven??o. Discuss?o: os resultados quantitativos s?o coerentes com outros achados da literatura sobre interven??es de TCD no contexto de dist?rbios da alimenta??o, e demonstram que uma interven??o breve baseada na TCD e adaptada ao contexto brasileiro pode ser efetiva para reduzir comportamentos alimentares problem?ticos e promover comportamentos mais adaptativos em curto e m?dio prazo, no entanto n?o s?o conclusivos quanto ? manuten??o em prazos superiores a 8 meses. Os dados do estudo qualitativo replicaram em parte outros achados da literatura sobre a TCD para pessoas com desregula??o emocional e transtorno limite de personalidade, ressaltando a import?ncia de que os cl?nicos estejam atentos ?s experi?ncias emocionais aversivas durante o grupo, oferecendo suporte e identificando oportunidades de aplica??o das habilidades treinadas durante o o pr?prio grupo. 29 Ademais, a percep??o de melhora nas rela??es interpessoais reflete a import?ncia da dimens?o interpessoal na problem?tica da obesidade e da compuls?o alimentar, dando realce ? forte rela??o entre aspectos interpessoais e respostas emocionais ?s quais podem se seguir estrat?gias maladaptativas de enfrentamento como a sobreingesta de alimentos.

Submitted by Caroline Xavier (caroline.xavier@pucrs.br) on 2017-06-30T17:24:36Z No. of bitstreams: 1 DIS_JULIA_LUIZA_SCHAFER_PARCIAL.pdf: 1950516 bytes, checksum: d087e3b380f5026a78af786f693a37b3 (MD5) / Made available in DSpace on 2017-06-30T17:24:36Z (GMT). No. of bitstreams: 1 DIS_JULIA_LUIZA_SCHAFER_PARCIAL.pdf: 1950516 bytes, checksum: d087e3b380f5026a78af786f693a37b3 (MD5) Previous issue date: 2017-03-08 / Conselho Nacional de Pesquisa e Desenvolvimento Cient?fico e Tecnol?gico - CNPq / Introdu??o: A literatura sugere que respostas emocionais est?o associadas ao desenvolvimento e manuten??o de sintomas do Transtorno de Estresse P?s-Traum?tico (TEPT). A capacidade de influenciar a experi?ncia e express?o emocional, conhecida como regula??o emocional (RE), pode ser cr?tica ao lidar com n?veis significativos de estresse. Especificamente, a RE atrav?s de cogni??es, ou pensamentos (ou seja, Regula??o Emocional Cognitiva, REC), ajuda os indiv?duos a manter o controle sobre sua experi?ncia emocional durante, ou depois de serem expostos a eventos estressores, ou traum?ticos. O Question?rio de Regula??o Emocional Cognitiva (CERQ), foi desenvolvido para medir nove diferentes estrat?gias de REC que se referem ? maneira consciente e atencional de lidar com eventos de vida amea?adores, ou negativos. Objetivos: Os objetivos gerais desta disserta??o foram desenvolver e investigar as evid?ncias de validade da vers?o brasileira do CERQ (Estudo 1) e investigar a rela??o entre a exposi??o a traumas, estrat?gias cognitivas de RE, afeto e Sintomas de Estresse P?s-Traum?tico (SEPT) atrav?s de um modelo de media??o dupla (Estudo 2). M?todo: Uma amostra de 445 estudantes universit?rios completou um Question?rio S?cio-Demogr?fico, a Life of Events Checklist (LEC-5), a vers?o brasileira do CERQ, a Positive and Negative Affect Schedule (PANAS) e a Posttraumatic Symptoms Checklist (PCL-5) em uma plataforma de pesquisa on-line. Para o Estudo 1, o processo de adapta??o da vers?o brasileira do CERQ incluiu tradu??o, retro-tradu??o, avalia??o de ju?zes e teste em 30 participantes da popula??o-alvo. As evid?ncias de validade de construto foram avaliadas atrav?s de an?lise fatorial confirmat?ria, da consist?ncia interna atrav?s dos alfas de Cronbach e de correla??es com as vari?veis afetivas mensuradas pelo PANAS. Para o Estudo 2 foram realizadas an?lises preliminares de correla??o e de regress?o linear m?ltipla para investigar associa??es entre tipo de trauma, estrat?gias cognitivas de regula??o emocional, afeto e severidade de SEPT. Em seguida, um modelo com rumina??o e afeto negativo como mediadores do efeito da exposi??o ao trauma les?o moral causada por outros sobre os SEPT foi testado usando o macro PROCESS para o SPSS. Resultados: As an?lises de validade mostraram que a estrutura original do CERQ possui boa validade fatorial na amostra e alta confiabilidade, com ? de Cronbach variando entre .71 e .88. An?lises preliminares de associa??o entre tipo de trauma, estrat?gias de regula??o emocional cognitiva, afeto e SEPT mostraram que o tipo de trauma de les?o moral causada por outros, rumina??o e afeto negativo s?o preditores significativos da gravidade de SEPT. Ao testar o modelo de media??o dupla, os resultados sugerem que a rumina??o ? um mediador forte e independente entre o tipo de trauma de les?o moral causada por outros e SEPT, enquanto afeto negativo ? um mediador apenas quando a rumina??o est? presente no modelo. Discuss?o: Nossos resultados indicam que a vers?o brasileira do CERQ ? uma ferramenta v?lida e confi?vel para avaliar as estrat?gias cognitivas de regula??o emocional e que os indiv?duos expostos ao tipo de trauma de les?o moral causada pelos outros utilizam rumina??o como uma estrat?gia de regula??o emocional cognitiva com mais frequ?ncia. O uso aumentado dessa estrat?gia amplifica os n?veis de afeto negativo que acaba levando a n?veis mais elevados de SEPT. Em geral, esses resultados podem influenciar pesquisas e auxiliar no desenvolvimento e melhoria de interven??es cognitivas para indiv?duos expostos a eventos traum?ticos. / Background: Literature suggests that emotional responses are associated to the development and maintenance of Posttraumatic Stress Disorder (PTSD) symptoms. The ability to influence emotional experience and expression, known as emotion regulation (ER), can be critical when dealing with significant levels of stress. Specifically, ER through cognitions, or thoughts (i.e. Cognitive Emotion Regulation; CER), helps individuals to maintain control over their emotional experience during, or after being exposed to stressful, or traumatic events. The Cognitive Emotion Regulation Questionnaire (CERQ) was developed to measure nine different CER strategies that refer to the conscious and attentional way people deal with threatening, or negative life events. Objectives: Therefore, the general purposes of this thesis were to develop and evaluate validity evidences of the Brazilian version of the CERQ (Study 1) and to investigate the relationship between trauma exposure, cognitive emotion regulation strategies, affect and Posttraumatic Stress Symptoms (PTSS) testing for a double mediation model (Study2). Method: A sample of 445 university students completed a Socio-Demographic Questionnaire, the Life of Events Checklist (LEC-5), the Brazilian version of the CERQ, the Positive and Negative Affect Schedule (PANAS) and the Posttraumatic Symptoms Checklist (PCL-5) on an on-line research platform. For Study 1, adaptation process of the Brazilian version of the CERQ included translation, backtranslation, expert committee?s evaluation, and testing on 30 participants from the target population. Validity evidence was assessed through confirmatory factor analysis, internal consistency through the Cronbach?s alpha analysis, and correlations with the affective variables measured by the PANAS. For Study 2, preliminary correlation and multiple linear regression analyses were conducted to investigate associations among trauma type exposure, cognitive emotion regulation strategies, affect and PTSS severity. Next, a model positing rumination and negative affect as double mediators of the effect of trauma type of moral injury by others on PTSS was tested using the PROCESS macro for SPSS. Results: Validity analyses showed that the original structure of the CERQ has good factorial validity in the sample and high reliabilities, with Cronbach?s ? ranging between .71 and .88. Preliminary analyses of the association among trauma type, cognitive emotion regulation strategies, affect and PTSS showed that trauma type of moral injury, rumination and negative affect were significant predictors of PTSS severity. When testing for the double mediation model, results suggested that rumination is a strong and independent mediator between trauma type moral injury by others and PTSS, while negative affect is a mediator only when rumination is also included. Discussion: Our results indicate that the Brazilian version of the CERQ is a valid and reliable tool for assessing cognitive emotion regulation strategies, and that individuals who are exposed to trauma type of moral injury by others engage more frequently in rumination as a cognitive emotion regulation strategy, which in turn amplifies levels of negative effect that ends up leading to higher levels of PTSS. Overall, these results can influence further researches and aid the development and improvement of cognitive treatment interventions for individuals exposed to traumatic events.